Provider Demographics
NPI:1801147475
Name:DICKENS-ROGERS, DIANE (REGISTERED NURSES RN)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:DICKENS-ROGERS
Suffix:
Gender:F
Credentials:REGISTERED NURSES RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 W. CHICAGO AVE.
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651
Mailing Address - Country:US
Mailing Address - Phone:773-287-7601
Mailing Address - Fax:
Practice Address - Street 1:5700 W. CHICAGO AVE.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651
Practice Address - Country:US
Practice Address - Phone:773-287-7601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-198732174H00000X, 374T00000X
IL529467-07225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174H00000XOther Service ProvidersHealth Educator
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel